Health Care Utilization and Behavior Changes After Workplace Genetic Testing at a Large US Health Care System

PURPOSE: This study explored employee health behavior changes and health care utilization after workplace genetic testing (wGT). Wellness-program-associated wGT seeks to improve employee health, but the related health implications are unknown. METHODS: Employees of a large US health care system offering wGT (cancer, heart disease, and pharmacogenomics [PGx]) were sent electronic surveys. Self-reported data from those who received test results were analyzed. Descriptive statistics characterized responses, whereas logistic regression analyses explored correlates of responses to wGT. RESULTS: 53.9% (n = 418/776) of respondents (88.3% female, mean age = 44 years) reported receiving wGT results. 12.0% (n = 48/399) received results indicating increased risk (IR) of cancer, 9.5% (n = 38/398) had IR of heart disease, and 31.4% (n = 125/398) received informative PGx results. IR results for cancer and/or heart disease (n = 67) were associated with health behavior changes (adjusted odds ratio: 3.23; 95% CI 1.75, 6.13; P \u3c .001) and health care utilization (adjusted odds ratio: 8.60; 95% CI 4.43, 17.5; P \u3c .001). Informative PGx results (n = 125) were associated with medication changes (PGx-informative: 15.2%; PGx-uninformative: 4.8%; P = .002). CONCLUSION: This study explored employee responses to wGT, contributing to the understanding of the ethical and social implications of wGT. Receiving IR results from wGT may promote health behavior changes and health care utilization in employees

Maternal restrictive feeding and eating in the absence of hunger among toddlers: a cohort study

Abstract Background Restrictive feeding by parents has been associated with greater eating in the absence of hunger (EAH) among children, a risk factor for obesity. However, few studies have examined the association between restrictive feeding and EAH longitudinally, raising questions regarding the direction of associations between restrictive feeding and child EAH. Our objective was to examine the bidirectional prospective associations between restrictive feeding and EAH among toddlers. Methods Low-income mother-child dyads (n = 229) participated when children were 21, 27, and 33 months old. Restriction with regard to food amount and food quality were measured with the Infant Feeding Styles Questionnaire. EAH was measured as kilocalories of food children consumed after a satiating meal. A cross-lagged analysis adjusting for child sex and weight-for-length z-score was used to simultaneously test cross-sectional and bidirectional prospective associations between each type of restriction and children’s EAH. Results At 21 months, mothers of children with greater EAH reported higher restriction with regard to food amount (b = 0.17, p < .05). Restriction with regard to food amount at age 21 months was inversely associated with EAH at 27 months (b = −0.20, p < .05). Restriction with regard to food amount at 27 months was not associated with EAH at 33 months and restriction with regard to food quality was not associated with EAH. EAH did not prospectively predict maternal restriction. Conclusions Neither restriction with regard to food amount nor food quality increased risk for EAH among toddlers. Current US clinical practice recommendations for parents to avoid restrictive feeding, and the potential utility of restrictive feeding with regard to food amount in early toddlerhood, deserve further consideration.https://deepblue.lib.umich.edu/bitstream/2027.42/140394/1/12966_2017_Article_630.pd

Increasing vegetable intakes: rationale and systematic review of published interventions

Purpose While the health benefits of a high fruit and vegetable consumption are well known and considerable work has attempted to improve intakes, increasing evidence also recognises a distinction between fruit and vegetables, both in their impacts on health and in consumption patterns. Increasing work suggests health benefits from a high consumption specifically of vegetables, yet intakes remain low, and barriers to increasing intakes are prevalent making intervention difficult. A systematic review was undertaken to identify from the published literature all studies reporting an intervention to increase intakes of vegetables as a distinct food group. Methods Databases—PubMed, PsychInfo and Medline—were searched over all years of records until April 2015 using pre-specified terms. Results Our searches identified 77 studies, detailing 140 interventions, of which 133 (81 %) interventions were conducted in children. Interventions aimed to use or change hedonic factors, such as taste, liking and familiarity (n = 72), use or change environmental factors (n = 39), use or change cognitive factors (n = 19), or a combination of strategies (n = 10). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 116 (83 %) interventions, but the majority of effects seem small and inconsistent. Conclusions Greater percent success is currently found from environmental, educational and multi-component interventions, but publication bias is likely, and long-term effects and cost-effectiveness are rarely considered. A focus on long-term benefits and sustained behaviour change is required. Certain population groups are also noticeably absent from the current list of tried interventions

MDMA Is Not Ecstasy: The Production of Pharmaceutical Safety through Documents in Clinical Trials

Nonprofit efforts to develop ±3,4‐methylenedioxymethamphetamine (MDMA)—better known as the street drug Ecstasy—as a prescription pharmaceutical provide the opportunity to examine recent theorizations of pharmaceuticals as fluid objects transformed in new informational and material environments. Drawing from ethnographic research, this article interrogates MDMA researchers’ own distinction between MDMA and the street drug Ecstasy. While researchers maintain that pure MDMA is distinct from Ecstasy, this article argues that the difference between the two hangs not on a distinction in substance, but on a distinction in safety that must be produced through the trial. This article tracks the production of safety through the inter‐connected work of clinical documents, which manage both which bodies are allowed to absorb the drug and which bodily events count as effects. MDMA’s safety emerges from the careful management of relations through these documentary practices.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167133/1/maq12548_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167133/2/maq12548.pd

Affecting Chemicals: An Ethnography of Clinical Research, MDMA (Ecstasy), and the Experimental Structuring of Effects

This dissertation ethnographically follows the efforts of researchers to develop MDMA (Ecstasy) as a prescription pharmaceutical. In the 1970’s MDMA became popular among psychedelic therapists as a legal alternative to banned substances like LSD and psilocybin. However, legal MDMA-assisted therapy came to a halt in 1985 when the Drug Enforcement Agency (DEA)—reacting to recreational use of MDMA in nightclubs—classified the drug as a Schedule 1 substance—which has no therapeutic application. In the decades following, activists, therapists and researchers have organized clinical trials with MDMA in order to contest the scheduling. The dissertation is based upon in depth ethnographic fieldwork with the Multidisciplinary Association for Psychedelic Studies (MAPS), which has sponsored an international clinical trial program on MDMA-assisted therapy. If successful, these studies will provide the basis for the organization to petition the Food and Drug Administration to approve a novel pharmaceutical treatment. This dissertation examines the ways that various practices of experimentation grant robustness to the chemical, the body, and even experience. The shift to epistemological practice that characterizes this work as a whole is an effort to avoid the constructivist bind by focusing not on what MDMA is or is not, or what it does or does not do, or when it is or is not agentive, but rather how it is apprehended. At several junctures, I argue that the chemical cannot speak for its own identity, but rather requires documentary, regulatory and experimental structures to guarantee it. The focus on practice in my dissertation allows MDMA’s status to remain fraught and allows central tensions to manifest—such as the distinction between MDMA and Ecstasy, which is central to MAPS clinical trial program. I argue that understanding the political work of these trials requires close attention to the minute practices of experimentation at work in clinical research